212205 08/28/2012 CITY OF CARMEL, INDIANA VENDOR: 362355 Page 1 of 1
ONE CIVIC SQUARE G H S
0 � CHECK AMOUNT: $627.00
CARMEL, INDIANA 46032 8349 N WASHINGTON STREET
SHERIDAN IN 46069 CHECK NUMBER: 212205
CHECK DATE: 8/2812012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4350100 26217 2012-1349 627 . 00 CONVERT 2X2 FIXTURES
GHS, Inc.
GuarantecA
Women-Owned Business Enterprise
9349 North Washington Street HW,st
Sheridan, IN 46069 Srrricr.
ING-
Bill To Invoice
City of Carmel Police Department
Attn: Teresa Anderson Date Invoice#
3 Civic Square
Carmel,IN 46032 8/20/2012 2012-1349
P.O. No. Due Date Terms
26217 9/19/2012 Net 30
Quantity Descriotion Price Each Amount
1 4 2x2 LED lamps and 4 2x2 reflectors to convert from U-tube to 627.00 627.00
straight LED tubes;8 LED lamps
We appreciate your business Total $627.00
Payments/Credits $0.00
A 1.5%Service Charge will be assessed on amounts over 30 days past due. Balance Due $627.00
INDIANA RETAIL TAX EXEMPT PAGE
Qityo fCarmel CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 28297
3 35-60000972
ONE CIVIC`:-SQUARE THIS NUMBER MUST APPEAR ON INVOICES,A/P
CARMEL, INDIANA 46032-2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS,
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL- 1997 SHIPPING LABELS AND ANY CORRESPONDENCE.
'URCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
MAW2
8,
OHS, Inc. C ol-Police Depaftmon@
VENDOR SHIP 3 CIVIC Squm
OW�Noith VIfthhington Street TO Cu toll,]IRlq/p46
Shoddan, IN �i{4f3L1STt7 (3,17)5Y 1°Ci7G78
CONFIRMATION BLANKET I CONTRACT PAYMENTTERMS FREIGHT
QUANTITY �pUNIIT RE OF MEASU DESCRIPTION UNIT PRICE EXTENSION
Account 43.01g.09
4 Each convert W fioturezrinstall 24°LED lamps $935.75 $627.00
Sub Total: $327.00
Q
v
EstTtrr>tf! o9�24 �0 H
Send Invoice To:
Carmel Police DepzAnoen4
Attn:Teroca Anderson
3 Civic squaam
Cafmel, IN 4t 2= PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
armel Police Dept. �;� -- X7.09
-' PAYMENT
• A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
\\ NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THATTHEJi3E IS AN UNOBLIGATED BALANCE IN
•SHIP REPAID.
THIS APPROPRIATIO UFF •TENT TO PAY FOR THE ABOVE ORDER.
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED.
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY SHIPPING LA6ElS. Old����II�B
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE
AND ACTS AMENDATORY THEREOF MAO SUPPIEMENT THERETO.
CLERK-TREASURER
)OCUMENT CONTROL NO. 26217 A.P.V. COPY-SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO._ WARRANT NO.
ALLOWED 20
IN THE SUM OF $
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except.-___
_ 20
----------------------------------_
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No.201 (Rev.1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or bill to be properly itemized must show: kind of service,where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
08/20/12 2012-1349 LED conversion $627.00
1 hereby certify that the attached invoice(s), or bill(s), is(are)true and correct and I have audited same in accordance
with IC 5-11-10-1.6
20
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
GHS, Inc.
IN SUM OF $
8349 North Washington Street
Sheridan, IN 46069
$627.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT
Board Members
26217 I 2012-1349 I 43-501.00 I $627.00 1 hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
Thursday, August 23, 2012
w
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund